AMCIT REPATRIATION HIGHLIGHTS ZIM'S CRUMBLING HEALTH INFRASTRUCTURE

UNCLAS SECTION 01 OF 03 HARARE 001007



SIPDIS



E.O. 12958: N/A

TAGS: CASC, AMED, CMGT, PGOV, SOCI, ZI

SUBJ: AMCIT REPATRIATION HIGHLIGHTS ZIM'S CRUMBLING HEALTH

INFRASTRUCTURE



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INTRODUCTION AND SUMMARY

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1. While the quality and level of HEALTH care available in Zimbabwe

was historically among the best in Africa, it has declined

dramatically in recent years and the decline has accelerated in the

last two to three months. Harare's three public hospitals lack even

basic levels of medical supplies and staff, and there are many

reports of hospitals refusing to provide basic medical services.

Even private hospitals face challenges with unreliable supplies of

water, lack of basic medical supplies, and staff shortages. The

recent hospitalization and medical repatriation of an AMCIT from

Harare shatters any lingering hopes that those with sufficient funds

can still obtain adequate medical care in Zimbabwe.



BACKGROUND

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2. On October 11, a long-term AMCIT resident of Zimbabwe sustained

a complicated fracture of his hip after falling in the bathroom of

his home. He and his Zimbabwean wife attempted to receive medical

care between October 12 and 21, making five visits to Zimbabwe's

flagship public hospital, Parirenyatwa Hospital. During each

attempt, AMCIT and his wife were told to go away and come back,

either because the doctor was not available or because they did not

have sufficient funds to pay for the consultation and x-ray. On

October 20, AMCIT contacted the Consular Section for the first time,

requesting help to pay for an x-ray. The Consular Section

authorized the remaining funds from an Emergency Medical Dietary

Association(EMDA) loan that he had previously requested to pay for

medication to treat his epilepsy. On October 21, with funds in

hand, AMCIT and his wife made their fifth and final attempt to see a

doctor and get an x-ray at Parirenyatwa Hospital, but they were told

that the hospital could no longer provide this service, even with

advance payment. (NOTE: Several doctors who work at the hospital

have since told us that x-ray film is not currently available in any

of Harare's three public hospitals. END NOTE.)



A DEARTH OF MEDICAL SERVICES

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3. After failing to obtain medical care at Parirenyatwa Hospital,

AMCIT and his wife came to the Embassy on October 23 requesting

emergency medical service. Unable to walk, AMCIT remained in his

car near the Embassy, where Conoff and Consular Assistant met him.

AMCIT appeared to be in a great deal of pain, disoriented, and

suffering from memory loss. At Conoff's request, Post Medical

Officer quickly assessed AMCIT's condition and determined that he

needed urgent HEALTH care. Post Medical Officer arranged for a

private doctor often used by the Embassy to see him. This doctor

arranged for an x-ray at a private facility and diagnosed a broken

hip; the consultation cost USD 20.



4. The following day, AMCIT met with an orthopedic surgeon who said

that surgery on the broken hip would cost at least USD 3500;

however, the surgeon refused to treat or give AMCIT a painkiller

until AMCIT had been admitted to hospital. Avenues Clinic, Harare's

premier private hospital, advised Consular Assistant that treatment

for 3-5 days would cost USD 4300 and that the hospital would require

either payment in advance or a guarantee letter from the Embassy.

This was in addition to the surgeon's fees and did not include

expenses for the pins and metal plate needed to fix the hip, or for

any necessary blood work, medications, or x-rays.



5. On AMCIT's behalf, Conoff negotiated with the hospital to accept

payment in local currency by check. This quickly reduced the

hospital's demanded payment from USD 4300 by 95 percent to USD 200.

(NOTE: Due to currency fluctuations, the final price was

approximately USD 20. END NOTE.) Conoff and CA/OCS arranged special

authorization for a repatriation loan before AMCIT checked into

Avenues Clinic on October 27. Visiting the hospital in advance of

AMCIT's surgery originally scheduled for October 29, Conoff

discovered AMCIT lying in urine-soaked sheets, without his hip

immobilized; additionally, AMCIT appeared to be more disoriented

than he was at the time of admission. Over the next two days,

despite repeated phone calls and several visits to the hospital,

Conoff and Consular Assistant were unsuccessful in their efforts to

contact AMCIT's attending surgeon.



6. On October 30, the surgeon informed Conoff, Consular Assistant,

and Post Medical Officer that he wouldn't be able to operate the

following day as he had previously planned because AMCIT needed a

blood transfusion. When Conoff asked why this had not been

mentioned before, the surgeon admitted that he had not been able to

locate any blood. After learning of Conoff's proposal to medically

evacuate AMCIT, the surgeon stated that because AMCIT's condition

was so poor he was glad that he would not be performing the surgery

because he did not think there would be a good outcome. Before

leaving, Conoff asked the surgeon to prepare a medical report and to

sign the consent form needed to transfer AMCIT by air. The surgeon

referred Conoff to his office manager, who refused initially to fill



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out the paperwork until the surgeon's consultation fees --

approximately USD 350 -- were paid, but eventually relented after

the surgeon agreed to complete the report prior to payment. A

larger repatriation loan was arranged for AMCIT so he could be

medically evacuated to the U.S. via South Africa.



7. The same day, nurses at Avenues Clinic informed us that they had

very few basic medical supplies. They said the surgeon operated

almost every day and was overworked, like most other doctors at the

hospital. Earlier in the day, Poloff learned from the doctor in

charge of emergency medical services at Avenues Clinic that the

hospital had no saline and could not even do intravenous drips for

patients who were dehydrated.



TRANSFER TO SOUTH AFRICA

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8. In anticipation of a medical evacuation, Consular Assistant

first contacted Zimbabwe's primary medical evacuation company,

Medical Air and Rescue Services (MARS),on October 27 for a quote

for their services and a timeline as to when the AMCIT could be

evacuated. MARS was unable to give us a written quote until close

to 5pm on October 30. They stated in their initial conversations

with Consular Assistant that they would be unable to provide a

medical escort. MARS also would not evacuate AMCIT without a report

from the attending surgeon -- something that proved extraordinarily

difficult to attain because of increasingly unreliable phone

service. MARS declared that a report from Avenues Clinic would be

insufficient for transportation. We investigated using a commercial

airline as an alternative, but they require 48 hours notice and a

hospital and doctor's report. Ultimately, the commercial airlines

refused to board AMCIT because the doctor's report stated that he

needed oxygen -- a requirement that the commercial airlines will not

meet.



9. On October 31, AMCIT was flown from Harare to Johannesburg in a

MARS-owned private plane. He was attended to by a nurse during the

flight and arrived at approximately 1:30 p.m. MARS had recommended

that AMCIT be checked into Milpark Hospital, ONE of the premier

hospitals in Johannesburg. MARS stated that they would notify

Milpark requesting admission. Neither MARS nor Milpark told Conoff

or ACS Johannesburg that a guarantee letter would be required for

admission, which delayed AMCIT's admission for five hours.



10. The admitting nurse told us that on admission at Milpark

Hopsital, AMCIT was severely dehydrated, delusional, and suffering

from malnourishment and a bed sore. The nurse believed that AMCIT

hadn't been bathed in more than 5 days. She stated AMCIT's

condition was serious and that he would not be able to travel for a

minimum of 10 days. The nurse was concerned by AMCIT's delusional

state and his very low hemoglobin level. She told Conoff that it

was quite possible that AMCIT would suffer a stroke or require

further emergency medical services or intervention given the poor

care he had received in Zimbabwe.



11. Conoff also spoke to the Director of Alliance International

Medical Services (a South Africa-based company),Bernadette Breton,

who said that AMCIT's condition was "appalling" and that MARS had

not followed the proper procedures for medically evacuating him to

South Africa. She said MARS should have contacted Alliance

International Medical Services prior to AMCIT's arrival and arranged

for the embassy to provide a guarantor letter for AMCIT's care. She

said that Milpark Hospital initially refused AMCIT's admittance

because they were concerned by the severity of his medical condition

and that the American Embassy would not pay the potential USD 20,000

that AMCIT could incur if he had a stroke or required further

medical intervention.



12. On November 3, the nurse in charge of AMCIT's care reported

AMCIT was doing much better. The hospital had been able to

successfully treat his bedsore and AMCIT was no longer delusional

after receiving two days of epilepsy medication. ACS Johannesburg

has arranged for AMCIT to have his hip repaired in South Africa

before medically evacuating him to the United States.



COMMENT

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13. The dearth of medical services available in Harare and the

apparent disregard by the treating physician and hospital staff for

the AMCIT's welfare in this case makes Consular Harare believe that,

except for the most basic medical services, AMCITs in Zimbabwe will

need to be medically evacuated in the future to ensure they receive

adequate medical attention. Since AMCIT's repatriation, ACS Harare

and Poloff have been meeting with doctors and other local medical

contacts. Poloff and Conoff have confirmed that saline, blood,

clean bandages, and other basic necessities, including water, are

not consistently available at any medical facility in Harare, even

the premier private hospital. This, coupled with very low wages has

resulted in many doctors, nurses, and support staff no longer

showing up to work. Those who do are overworked, under-motivated,



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and sometimes give sub-par medical care unless they are paid "extra"

by the attending doctor or patient's family. The result is that

Zimbabweans -- and now Americans -- can no longer count on receiving

even the most basic medical care during a life threatening accident

or illness.



MCGEE